肝脏疾病(本科)彭涛2011.ppt

* 肝脓肿 - 症状 体征 一般情况差（不适、疲乏）、寒战、弛张热、黄疸 右上腹痛、右肩牵涉痛、肝肿大、触痛、胸膜渗出 * 肝脓肿 - 实验室检查 白细胞升高见于绝大多数病例 贫血、Hematocrit↓ Bilirubin, ALP ↑ * 肝脓肿 - 影像学 平片 (右胸): 基底段不张、胸膜渗出、右膈上抬、运动度↓ 平片 (腹): 肝肿大、气液平面、胃形态改变 US, CT scans: 提供病灶位置、大小、数目的准确信息 * A case Hepatic Abscess from Streptococcis Milleri A 58-year-old male complained about rash over the legs and lower back, arthralgias and soaking night sweats which had started about one week before his clinic visit. An ultrasound examination demonstrated multiple hypoechoic lesions in the liver measuring up to 4.3x3.3 cm with increased blood flow to the periphery. On contrast-enhanced CT scan, these lesions appeared hypodense. (Klaus Bielefeldt, et al.) * 肝脓肿 –鉴别诊断 其他引起不适、消瘦、贫血、发热的疾病 阿米巴肝脓肿（Amebic abscess）: 流行区旅居史A history to endemic area 单发Solitary abscess 疼痛、触痛、腹泻、肝肿大、血清学 amebiasis (+). 细菌性肝脓肿 （Pyogenic abscess）: 常见于老年患者 黄疸、搔痒 、脓毒血症、包块、bilirubin?, ALP? * 肝脓肿 –并发症 肝内播散（多发脓肿） 破裂（胸腔、腹腔） 败血症, 感染中毒性休克 肝功能衰竭 胆道出血 * 肝脓肿 –治疗 抗生素：usually aminoglycoside, clindamycin or metronidazole and ampicilin, 应覆盖E Coli, K pneumoniae, Bacteroides, enterococcus, and anaerobic streptococci, and be modified according to cultures. US or CT引导下经皮穿刺置管引流适用于大多数病例 部分病人需要开腹引流或肝叶切除 Thank You！ Questions？ * Parkin DM,Bray F,FerlayJ,Pisani P.Global cancer statistics 2002.CA Cancer J Clin. 2005;55 ( 2 ):74 – 108 * PS: performance status，ECOG体能状态评分 CP: Child-Pugh 评级 * Llovet JM et al. N Engl J Med 2008;359:378-90. Sorafenib in Advanced Hepatocellular Carcinoma Cheng AL et al. Efficacy and safety of sorafenib in patients in the Asia-Pacific region with advanced hepatocellular carcinoma: a phase III randomised, double-blind, placebo-controlled trial. Lancet Oncology, Published online December 17, 2008 * Bacteroides 拟杆菌属 * 转移性肝癌-背景 发生率较HCC高20倍 约50%来自消化系统 分型：同时性转移，异时性转移 常见原发灶: 乳腺、肺、胰腺、胃、大肠、肾、卵巢、子宫… 途径: 体循环、门静脉、淋巴、邻近肿瘤侵犯 * Metastatic neoplasms of the liver The numerous mass lesions that are of variable size. Some of the larger ones demonstrate central necrosis. The m